Local Government and Public Involvement in Health Bill

I am grateful for what the Minister has said, but I am sure that he will agree that with regard to the governance of all local authorities, the Bill says that they have to conform to one of the three new models, and if they do not happen to do so already, the status quo is not an option. There is no question of that situation being endorsed by a referendum before things are imposed by the Secretary of State. The point that the Liberal Democrats want to make is: why is it for the Government to intervene in the internal governance of local authorities? If there were any evidence at all that the performance of local authorities is adversely affected by one or other of the governance systems that are in place, perhaps the Government would have a case. I had a talk with a number of local government consultants who give advice on these matters, and their view was that the best that could be said of the Government’s proposals is that they will not make the situation worse. There is no question of their leading to an improvement. There is no possible way in which that could be measured. Let us consider the models and look at the changes that the Secretary of State proposes to make to how mayors will come into existence in future. I was interested in what the Minister just said: in Stoke-on-Trent the system could not be changed because it was put in place by a referendum and another referendum is necessary to get rid of it. That is all very good, but what about mayors? There have been 32 referendums on the establishment of mayors, and in 20 cases voters have opposed the creation of mayors. That is two to one against mayors. There are 12 mayors in place, and without doubt some of them do excellent work. There are some good models, and some of them are doing better than their predecessor councils were. Obviously, I want to draw the House’s attention to the mayor of Watford in that context. However, the House also needs to understand that in four of the 12 cases there are active campaigns to get rid of mayors, because they are not seen as effective models at the local level. The Government’s solution is, ““Let’s take out the public participation in that decision. Let’s have mayors established not by popular preference but on the say-so of a council.”” It is not altogether surprising that the leaders of councils tend to be in favour of strong entrenched leadership. One does not have to be a rocket scientist to see why that might be so. When we consult leaders, funnily enough they are in favour of strong entrenched leadership. The question is: is that model good for local democracy, does it improve the delivery of services, and does it give good value for money? The answer is that there is no evidence at all to show that that is so. The proposal to have entrenched leaders, as opposed to mayors, seems to have been drawn up by somebody who had no knowledge whatsoever of local democracy. I was sorry for the Secretary of State, who had to respond to a string of questions on that point. She represents a constituency in which, for a period, no political party had overall control of the local authority. One third of all local authorities are in that position, and it is difficult to understand why she imagines that the strong leader model would be right for a council in which no party had overall control, or how a council with such a governance system would manage if it entered a period in which no party had overall control. Whoever worked out the proposal had evidently not looked at the statistics, because in half of the remaining local authorities—the two thirds in which there is a party with majority control—the leader’s average term of office is less than four years. What exactly is the model intended to deliver, and how will it do it? I have already commented on the difficulty that there will be for cabinets and cabinet slates; a whole set of issues will have to be explored. I point out in passing that it is a good job for the Scottish Parliament and Executive that the Bill was not in force earlier. Otherwise the past eight years would have been very difficult in Scotland, where there is a multi-party Executive. I heard the Secretary of State say that one of the reasons for going down the route proposed is that she will give enhanced powers to local government, which would therefore need strong, effective, centralised leadership to deliver results. That is fine, except for the fact that in the first half of the 20th century there was committee government even in the largest cities, and the committees dealt with public transport, and public utilities such as gas, sewage treatment and electricity. There was nothing that they did not do, and on the whole, they were leaders in those spheres. A lot has changed since then, but the idea that there could be no consensus if work was done by committees, whether multi-party or dominated by one party, and the idea that those committees could not deliver effective decisions, are not based on any proper historical analysis. We have severe concerns about the Bill’s proposed changes to governance, and we simply assert that it is for local government to determine how it should govern itself. We have allowed that for the colonies, so it does not seem excessive to allow it for local government. On a much smaller and entirely different issue, the Bill includes provisions relating to the powers of the Audit Commission. At the moment, the commission not only does work commissioned by the Government in respect of local authorities, but carries out work commissioned by local authorities on their own behalf, so that, for example, an authority can find out whether its social services department is delivering. The Bill proposes to remove the right of the Audit Commission to accept such work. Just when huge numbers of local area agreements are about to come into force, when there is to be much more co-operative and partnership working, and when issues of value for money and sensible organisation between several tiers of local authorities and public bodies are more important than ever, the Government are including a provision to prevent the Audit Commission from accepting a commission from bodies that want to look into how they provide services. I cannot imagine why that decision has been taken, but I shall be interested to learn the reason in Committee. A cynic might think that it has been done so that PricewaterhouseCoopers and KPMG can be taken on as consultants, at three times the price and half the credibility. [Interruption.] If the Minister for Local Government wants to tell me, either now or in Committee, why he thinks that is not true, I will listen, but the fact is that he is taking away that right of the Audit Commission, to the disadvantage of value for money, local government and the commission itself. The Secretary of State was quiet—whether from embarrassment or not, I do not know—about national health service reform. ““Reform”” ought to be in inverted commas, and we ought to add, and underline, the word ““again””. There are district nurses in my constituency who have had three different employers in three successive years, as trusts were moved around. Whether the policy of patient and public involvement in health has been in place for four years, two years or one year, the Government are now tearing up a system that they assured the House was the correct response to getting rid of community health councils. The loss of community health councils is lamented by all, except NHS administrators, whose subsequent record of control and management has, of course, caused the Government to tear their hair out. When CHCs were abolished and PPIH introduced, individual complaints were siphoned off and given to the NHS, which thus acted as judge and jury on complaints made against it. Whatever the merits of PPIH, the system is far weaker and more fragmented than it was under CHCs. Now PPIH is to be abolished. Hon. Members will have received copies of correspondence in which the first letter says, ““Dear PPIH member, thank you for all your help. Your job is now over.”” The second letter, however, says, ““Whoops, we acted a bit too quickly. Please stay on for a bit until we pass the legislation.”” Clause 162 proposes to abolish the Commission for Patient and Public Involvement in Health. Despite the fact that it has reduced powers compared with CHCs, and it is very much a creature of the system, it still has the capacity to bite, because it said of the Bill’s provisions:"““The Government has yet to report on the resources that will be available to local authorities to support LINks, and the formula to be used to distribute funding. When legislating in 2002 to establish PPI Forums and the CPPIH, Parliament also had no information about the intended budget and consequently many of the intentions of that legislation were unachievable due to funding restrictions applied later.””" The Commission itself says that it could not do the job that it was set up to do by Parliament, because the Government shrank its funding and kept it under strict control. As hon. Members have said, only primary care trusts are required to co-operate with the new system, not provider trusts or, in Stockport, the foundation trust that has just decided that it will no longer meet in public. I tabled a parliamentary question about that, and the answer that I got back was, ““That’s okay—it’s up to them.”” Not only are some important elements of the national health service omitted, but those that are omitted are the ones that are doing their best to get under cover and avoid public inspection. I understood that the code of practice for the Standards Board was to be put into the public domain today, before our debate, but evidently that did not happen. That code will be crucial in determining whether reform of the Standards Board will be workable and effective for local government. I make no bones about it: we think that the board should be abolished—but if it is to be reformed, that reform must be drastic and effective, and the process must be open to discussion and debate in the House. If the code is introduced in a statutory instrument, it will not be debatable, so I ask the Minister, when he replies to the debate, to make it absolutely clear that the code will be published before the Bill goes into Committee, so that we have the opportunity to consider it when we consider the relevant clauses. I understand that the code has been hotly debated by many people, none of whom has been democratically elected. They have all stirred the pot, so it is time the code was published so that we can all have a look at it. Even when the Government have got it half right in some parts of the Bill, they have still managed to get it half wrong as well. Whether it is internal governance, the powers of the Audit Commission, NHS reform, the Standards Board or a stack of other matters, there is a lists of defects and errors that must be tackled. The fundamental problem, however, emphasised and underlined time and again by sins of commission and omission, is that the Government do not have any respect or regard for local government.